https://doi.org/10.1093/jn/nxz087

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ORCID iD

Edward Frongillo: https://orcid.org/0000-0002-8265-9815

Document Type

Article

Subject Area(s)

Agriculture; Behavior Therapy; Child, Preschool; Cluster Analysis; Cross-Sectional Studies; Ethiopia; Growth Disorders (prevention & control); Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Mass Media

Abstract

BACKGROUND: Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM).

OBJECTIVES: The aim of this study was to evaluate the impact of A&T intensive compared with nonintensive interventions (standard nutrition counseling and agricultural extension service and less intensive CM and MM) on CF practices and knowledge and child anthropometric outcomes.

METHODS: We used a cluster-randomized evaluation design with cross-sectional surveys among households with children aged 6-23.9 mo [n = 2646 at baseline (2015) and n = 2720 at endline (2017)]. We derived difference-in-difference impact estimates (DDEs) and conducted dose-response and path analyses to document plausibility of impacts.

RESULTS: At endline, exposure to IPC was 17.8-32.3%, exposure to AG was 22.7-36.0%, exposure to CM was 18.6-54.3%, and exposure to MM was 35.4% in the intensive group. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: -5.6 percentage points; P < 0.05) in children aged 6-23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose-response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ.

CONCLUSIONS: Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552.

Digital Object Identifier (DOI)

https://doi.org/10.1093/jn/nxz087

APA Citation

Kim, S., Nguyen, P., Yohannes, Y., Abebe, Y., Tharaney, M., & Drummond, E. et al. (2019). Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia. The Journal Of Nutrition, 149(8), 1470-1481. https://doi.org/10.1093/jn/nxz087

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